Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 21183 | TX |
NPI | 1043479264 |
---|---|
Provider Name | Dwideshkumar Hiremath |
First Address | Keller, TX 76248 |
Second Address | Keller, TX 76248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 03/02/2016 |